Title                   First Name*                                                Last Name*

City*                                                        State*                                                     Zip*

Day Phone                                                                Evening Phone

How did you hear about the Mighty Men of Valor Conference?
Select One Television Partner Letter Word of Mouth Church Bulletin Internet VCMI Website TCBM Website Facebook Twitter Other (Please specify)   If other, please specify :

Will this be your first year attending the Mighty Men of Valor Conference?
Yes No

How are you connected with Pastors Tony and Cynthia Brazelton?
VCMI-Suitland Partner VCMI-DC Partner VCMI-Woodbridge Partner VCMI-Waldorf Partner TCBM Partner CCI Partner Streaming Faith Partner No Affiliation   If you are a CCI partner, please specify :